Practice Management Alert

Question: Our family-practice physicians often treat patients with mental-health conditions such as depression, anxiety and ADD/ADHD. We have tried reporting prolonged service codes (99354-99355) and    psychiatry codes (90801-90899) to account for the counseling services during these visits, but the medical carrier frequently bumps our claims over to a separate mental-health carrier. What are the most appropriate CPT codes to report the counseling services our physicians provide?

Texas Subscriber

Answer: If you're providing an E/M service to treat a patient for depression, anxiety or other mental conditions, and the physician spends more than 50 percent of the face-to-face encounter counseling the patient, the best choice would be to code by time for the visit.
 
For example: An established patient presents for treatment of depression, and your physician does a problem-focused physical exam and takes an expanded problem-focused history. During the 40-minute visit, the physician documents spending 30 minutes counseling the patient on how to handle the depression and summarizes the counseling content in his notes.
 
Normally the components of this exam may only add up to a level-one or level-two E/M, but because the physician documents that more than 50 percent of the visit consists of counseling, CPT allows you to use time as the determining factor to choose a level of service. In this case, you could report 99215 for the established patient visit because CPT indicates that this code typically includes 40 minutes of physician-patient time.
 
Prolonged service: If you code by time but your counseling service runs over and above the time requirements for even a level-five E/M, you may want to consider reporting a prolonged service code in addition to the basic exam code to account for the physician's extra time.